PSNC and NHS Employers review NMS payment structure following concerns

Thank goodness the PSNC are taking notice of contractors concerns regarding the NMS payments scheme. (I doubt its a small number of contractors!)
The NMS service is a fantastic idea and is of great benefit to patients as well as another step forward for our profession.
However the agreed payment structure is a complete disaster, being over-complicated and based on incorrect assumptions around the number of patients eligible for the scheme.
Kirit Patel warned the payment structure was over-complicated before the NMS scheme started and the PSNC should have paid some attention to the views of such an experienced pharmacist owner.

Despite the faults in the system, I do hope that contractors are behind the new service, collecting data on the actual number of eligible patients they see.

Even if patients don't engage, we need the numbers to support our arguments against the current payment structure.

Reporting this data back will allow us to argue against the 0.5% figure for new items from the initial research that has been used.

I agree the payment structure is over complicated. You could miss out on any payment if you miss the lowest target by 1.
The number of NMS is dependent on your location and the type of scripts you do.
Some pharmacists doing a large monthly script count are saying what is the point of doing any if you won't be paid anything if you miss minimum target by one!
It should be a simple payment per NMS done.

Your point was made numerous times by numerous LPCs before the start of the NMS and PSNC in their sheer arrogance decided to ignore the pharmacists who were going to actually provide the service. The service should always have been paid as one payment per NMS. Nothing else should be acceptable.

I had said this "the payment structure was over-complicated " long before Kirit. But no one bothered. Hope this time they do what they are saying they will do.

The PSNC and idealistic Pharmacists need to wake up and smell the coffee. NMS is just not adding up. I "embraced" NMS at the begining of October - I followed all the steps and being a very busy pharmacy recruited a locum for 3-4 days a week to help out. I bought a new terminal for my consultation room. Within a short period of time, my fantastic PMR (Positive Sotlutions) was identifying between 5 & 10 NMS cases a day. By the end of November, we were conducting up to 20 interventions and follow ups and still recuiting an additional 10. Many people we were having to ring several times before we got a response and hence it has become a full time job. On speaking to the PSNC today, I have just discovered that I will not be paid for the 19 NMS's that I have gone over my quota! Hence, I have been shafted to the tune of £475. The PSNC's response was to say I should look at just how many people I have helped! - As usual - FREE OF CHARGE. Now doing my sums, the money made from NMS won't even cover my locum costs. Sorry guys, I just ain't doing this any more. If I were a GP, I would not do anything for free, so why should I as a pharmacist! At the other end of the scale, the multiples are failing miserably at achieving anything near to target. So it ain't working for them either. Sorry PSNC, you have got this horribly wrong - and that comes from someone who has recruited 119 NMS patients in November - Please don't tell me that I need to embrace this - I would love to see if anyone has tried harder! We will soon be working for nothing.

R Cygan did not read the small print.
It was obvious from day 1 (and before) that you had quotas (20%, 40% etc.. ) and met these. Going over (between) the quotas would result in no payment and certainly no payment for going over 80%. I did discuss this with the LPC and told the answer.
There is one way to recover the outlay and that is to continue with NMS and claim for those you do up to the 80% target.
I am sorry, but R Cygan should have had smelt the coffee himself and read the facts before he started.

Fair enough, but even doing my quota of 100 does not cover my costs! 100 NMS's = 300 consultations by a pharmacist per month = 15 - 20 consultations a day (assuming 100% success rate in contacting people first time). Locum costs for 3 days a week = £3,120. Payment from NMS = £2,500. LOSS = £620 per month. Does it add up - NO! Clearly, Peter does not pay the bills in his pharmacy.

Long before I completed 10 NMS in October and realised that I'd reached my implementation payment but failed to reach the 20% mark (we dispensed 16,000 items) I realised what a crock the current payment system is.
The service is great and well received by some patients but the banded payment structure is making a tough implementation period even harder.
For example we've completed 15 this month. we have dispensed 15,964 items. So do I only submit 15,499 and deprive my employer of around £4,800 cash flow but get paid a whopping £375 for my NMS OR do I get the cash for scripts and forget the NMS?
It's going to be a really tough job getting to 40% next year. I will have to complete 32 per month or get nothing. My experience already having really fully embraced the service is that we are replicating what the GP practices are already doing and patients cannot see the point. "But I'm seeing the GP/practice nurse/support worker next week anyway" is what 90% tell us.
I had some medical students visit for training and work experience last week. They thought most of our advanced services are pointless as the GP is already contracted to provide this care. And in my expereince they actually do.
I'm glad the PSNC are revisiting this. Perhaps they could visit some pharmacies actively promoting and providing this service to see what could be done to help us?
But why stop at NMS.
Perhaps they could also revisit the whole contract and start to move away from an outdated, disproven and frankly worthless piecework contract to something which actually rewards hard working professionals for the care they tirelessly provide.
Ah but we'd need yet another illuminating cost of service inquiry first and I wonder who might have to foot the bill for that?

Absolutely spot on!!!!!

Hi
I only work in a small pharmacy and I don't pay the bills. My target is 20 per month, not that I will meet it. I have achieved 10 in November.
R Cygan must be doing 25000 items per month to get the quotas he stated.
The system is wrong, and we should be paid per NMS, to a max, based on script numbers, unlike MURs where everyone can only do the 400.
The concept of NMS (and other services) is to stop pharmacists dispensing and get us into the consulting room to do these things. It is hard to change but we are going to have to do it. There will be less and less money for dispensing and more for services.

Greg Hyde is right, a lot of patients are going back to have BP checks done to ensure their new med is working, so the patient does say why see us as well. But we should persevere, it will take a little (long??) while to get the breakthroughs.

Peter, bringing in NMS will not stop dispensing. In fact, at the moment year on year prescription numbers are growing at an alarming rate and so all that will happen is that the quality of our dispensing service will go down and down whilst we are pre-occupied with other tasks that are not covering our costs. In principle I agree that there MAY be role for pharmacists in carrying out consultations, but these should then be available to ALL patients, not just those within our quota (if they are to have any value - that is the basis of my argument) and certainly we should not be doing anything free of charge. The point you are missing is that we cannot do more and more and be paid less and less. GP's would not do it, so why should pharmacy do it. If a GP identifies 20 more patients that need a flu jab, he will be paid for administering those vaccines.In addition, we should not be ashamed of dispensing and making a profit from it. After all, UK pharmacies provide dispensing services for a fraction of what our counterparts do in europe. Patients still need to have their medicines dispensed somewhere. And pharmacy should be that place. With us doing more scripts, we need more staff - its all relative. More staff, means more costs. Also, it is not a question of it being "hard to change", clearly, in my case, I have. But it has to add up. However, doing services for the sake of them to try and justify a role for pharmacy is also wrong. In my experience, NMS has been good in parts but having done as many as I have, I have found that most patients initiated on the groups of medicines that we are looking at, have follow up visits at their surgeries any way and we are merely duplicating the tasks - GP's have QOF targets to meet, hence the incentive. As to break-throughs, I can't see it. Look at MUR's - these are merely a stick that area managers of the multiples use to hit their pharmacists with. Now NMS will become a similar stick. I really havn't heard anyone say MUR's are a resonding success. In the long term, if we are not careful, what we will see is one-stop shops within large GP surgeries (pharmacies owned by multiples or GP's themselves), mail-order and internet pharmacies and the rest of us will be left with non viable "pharmacies" trying to justify our costs by doing services that no one really wants.

I think Peter is aware that dispensing won't stop. What he is trying to say is that we have to move ourselves (i.e pharmacists) away from the benches to take on the new services. The only way this will happen is to have enough support staff with the right skill mix for whatever location you are in, and we have to learn to trust them.
This means investment and in the current climate most employers are not in a position to invest heavily in modernisation or expansion, especially when the margin keeps being squeezed in various ways by the DoH and the cost of service inquiry achieved nothing.
This leaves employee pharmacists stuck between a rock and a hard place. Yes it's a juggling act but as Peter says this should not deter us from trying. I've had some great feedback from customers using the NMS and nothing beats advertising like a customer shaking your hand and saying "thank you" in front of a pharmacy full of customers.
But I'm lucky. I have a fantastic team who I trust completely and unreservedly.
PSNC could do themselves a huge favour and regain a lot of support by revisiting this payment scheme sooner rather than later!

Greg, I don't disagree with what you are saying. I have had similar responses to those that you have had to NMS. I have built my pharmacy on service. Hence, why we have done well. There are always at least 3 pharmacists on duty, 5 ACT's, two dispensing robots etc., but this all costs money. Pharmacy must not to be seen to be doing anything that it does either cheaply or for free, because next time anything is offered, the argument is that pharmacy is happy to do the job for less, or worse still, for nothing. In 16 years as an independent contractor and dispensing consultant, I have seen things change dramatically, but rarely in a positive way. Year on year, the PSNC negotiates a worse deal. Just look at the current GP contract. Compared to their previous contract, GP's got an income increase of 50%, shorter working hours, no weekends and nights and a year later the on the back of this, the PSNC tried to negotiate our contract hailing it as "securing the future of pharmacy." It was that well secured that we had to receive emergency funding three years ago as we risked many pharmacys going under. If things are that good, why have pharmacy values fallen by up to 40% in the last three years? The future of pharmacy is far from secure, believe me, the issues I raised earlier about mail order and internet pharmacy are closer than people think, particularly with ETP2 just around the corner. If good, honest pharmacies with dedicated pharmacists providing top notch services, and in this list of services I include dispensing, are to survive WE MUST BE FUNDED PROPERLY.

you hit the nail on the head,NMS like MUR has indeed become a stick used in hitting employee pharmacists already, and frankly nearly all the patients have have recruited for NMS have made the statement 'my doctor says to come back in a month toe check howm getting on' duplicate.

I do agree with most of what you say.
All new medicines should be eligible for the NMS. I have transferred several Warfarin NMS into MURs, as patients had these from the hospital for the last month. Yes and BP drugs are being followed up by the GP.